Transcript Slide 1

Ma. Cristina S. Sombilon, M.D., F.P.S.P.
Department of Medical Humanities
UERMMMC College of Medicine
a
branch of philosophy
Practical
science of MORALITY of
human acts
Teaches
us how to judge accurately
the moral GOODNESS or BADNESS of
any human action
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
1. BENEFICENCE – ONE OUGHT TO DO GOOD
 Seek the patient’s well-being
 Provide standards of due care and
risk/benefit assessment
2. NON-MALEFICENCE – DO NO HARM
 Avoid unnecessary expense, consult,
procedures and medications
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
3. INFORMED CONSENT
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Provide the patient with a COMPLETE, ADEQUATE
DISCLOSURE of his illness and OPTIONS in a language
he understands for the patient to be able to make a
rational and free decision
4. AUTONOMY (RESPECT FOR PERSONS)
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Respect the patient’s rational decision as long as he
is aware of the consequences
The patient has a right to refuse
5. JUSTICE
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Allocating scarce resources fairly and according to
medical needs
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
 “life
ethics” – philosophical
 More
encompassing than medical ethics,
includes additional issues not necessarily a
part of medical ethics
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Medical ethics
Business ethics
Sexual ethics
Social ethics
Environmental policy and ethics
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
Medical
ethics is a “subset”
of bioethics

Clinical or case-based approach
Used
interchangeably
“BIOETHICS”
“MEDICAL ETHICS”
“BIOMEDICAL ETHICS”
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
MEDICAL ETHICS
abortion
 euthanasia
 confidentiality
 truth telling
 fair distribution of
resources
 informed consent
 research involving
human subjects
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Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
HIV/AIDS issues
 organ transplantation
 genetic engineering
 reproductive rights
and assisted
reproductive
techniques
 stem cell research
 human cloning
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BUSINESS ETHICS
 Corporate
responsibility
 Rights and obligations of employees
 Diversity and discrimination in the workplace
 Care for the environment from industry and
business
 Minimum wage vs. Living wage
 Age discrimination
 School discrimination
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
SEXUAL ETHICS
 Homosexuality
and gender sensitivity issues
 Prostitution
 Adultery
SOCIAL ETHICS
 Family
responsibility
 Distribution of social resources
 Society’s obligation to the poor
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
The
application of the GENERAL
PRINCIPLES of ethics to the
moral problems of the medical
profession
CORE:
ethics of a physicianpatient relationship (TRUST)
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
 Specific
RULES OF CONDUCT of
physician
 What
the physician PROVIDES for the
patient
 What
the physician’s DUTIES are to
the patient and VICE-VERSA
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
TRADITIONAL MEDICAL ETHICS
 Equality
of health care professionals
and patients
•
•
stewardship
autonomy
 Purpose
of health care is TOTAL PATIENT
CARE (value based ethics)
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
Duty
to help the patient:
BENEFICENCE
Duty
not to harm the patient:
NON-MALEFICENCE
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
 Coined
to cover PHILOSOPHICAL, LITERARY,
HUMANISTIC approaches to problems in
medicine
 Ethics
is an area of study in philosophy and
philosophy is a part of the humanities
 Contemporary
use of the term includes
LITERATURE, POETRY, FILM, MUSIC to
increase appreciation for the HUMANISTIC,
INTERPERSONAL, and EMPATHETIC aspects of
medicine
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
THE HEART
OF
MEDICINE
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
When and where was bioethics born?
ANCIENT HISTORY
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HIPPOCRATIC OATH – first code of medical ethics
 “first do no harm”
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A promise to respect a patient’s personal dignity
and privacy
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A promise to use medical knowledge FOR THE GOOD
OF THE PATIENT
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
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The oath and prayer of MAIMOINIDES (c. 1200)
 Rabbi Moshe Ben Maimon, a Jewish philosopher
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a meditative piece which implores physicians to look
at the sick with respect and dignity
OATH
“The eternal providence has appointed me to watch over the
life and health of Thy creatures. May the love for my art
actuate me at all times: may neither avarice nor
miserliness; nor thirst for glory or for a great reputation
engage my mind... ”
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
OATH OF MAIMOINIDES
“May I never see in the patient anything but a
fellow creature in pain.”
“...God, thou has appointed me to watch over
the life and death of Thy creatures; here am
I ready for my vocation and now I turn unto
Thy calling.”
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
PERCIVAL’S CODE (1794) – first code of medical
ethics adopted by a professional group of
physicians.
AMERICAN MEDICAL ASSOCIATION (AMA) – first
code of ethics was adopted in 1847 in
Philadelphia
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Duties and obligations of physicians to their patients
and vice-versa
Duties of physicians to society and medicine itself
Revised and updated over time
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
MODERN DAY BIOETHICS
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Emerged from the atrocities and scandals in
human experimentation
Horrific experiments performed on prisoners
by doctors in Nazi concentration camps
NUREMBURG MILITARY TRIBUNAL TRIALS
(Nov. 14, 1945 – Oct. 1, 1946)
NUREMBURG CODE – influenced the direction
of research ethics and policy
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
NUREMBURG CODE
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Code of ethics on human experimentation
Ten point statement delimiting permissible
medical experimentation on human subjects
First line emphasizes that VOLUNTARY
CONSENT of human subject is absolutely
essential in any experiment
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
MODERN DAY BIOETHICS
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A new discipline which tries to reconcile the
discrepancies between the 2400 year old
Hippocratic Code with today’s medico-moral
issues
FROM AN ETHICAL POINT OF VIEW, MEDICINE IS
THE VICTIM OF ITS OWN SUCCESS
Today in medicine, the CRITERION OF WHAT IS GOOD
(ethical or moral) is being replaced by WHAT IS USEFUL
(Utilitarianism)
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
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1966 article by Dr. Henry Beecher, Harvard Univ.,
in the New England Journal of Medicine (NEJM)
Several unethical and experimental research
programs in clinical research in the U.S.
Used unknowing human subjects exposed to
extreme health risks
“moral basis” or purpose is to advance scientific
knowledge
Other well publicized events in health care and
research questioned the norms of medical ethics
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
WILLOWBROOK STUDY/EXPERIMENT
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Infecting mentally retarded school
children of the Willowbrook State
School in New York with HEPATITIS
To study the course of the disease
Consent to the study became a
“prerequisite” for enrolment
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
TUSKEGEE EXPERIMENT
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1930s U.S. Government study
400 Black American men with SYPHILIS were
signed up to observe the course of the
disease
1949- discovery of a cure PENICILLIN
Treatment was DELIBERATELY WITHELD from
the subjects in order to observe the progress
of the disease and its complications until
death
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
TUSKEGEE EXPERIMENT
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“bad blood”
Patients lived with the disease until their
death, some in the 1970s
U.S. Gov’t. reparations and recognition of
these men did little to regain the trust of the
public in human experimentation
Only in the last term of Pres. W. Clinton was
a FORMAL APOLOGY to the families of the
Tuskegee victims given
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
MODERN DAY BIOETHICS CANDIDATES
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1962: LIFE magazine article by Shana
Alexander on the Seattle Artificial
Kidney Program
1967: Dr.Christiaan Barnard, South
Africa, first successful heart transplant
1973: Roe vs. Wade – U.S. Supreme
Court decision on abortion
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
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1974: exposure of Tuskegee Syphilis
study
1974: The National Commission for the
Protection of Human Subjects in
Biomedical and Behavioural Research
1976: Quinlan case – U.S. Supreme
Court decision on end-of-life
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
MODERN DAY BIOETHICS RECENT EVENTS
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1978: Drs. Patrick Steptoe and Robert
Edwards – first test tube baby (IVF) and
embryo transplant baby Louise Brown
1980s – present: HIV/AIDS
1991: the Patient Self-determination
Act (advanced directives, living will,
ethics committees)
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
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1996: Dolly, the first cloned sheep;
stem cell technology
2002: legalization of euthanasia in the
Netherlands, emergence of Right to
Die advocates and movement, Oregon
Death with Dignity Act
2007: Terri Schiavo – end of life case,
termination of feeding
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
BIOETHICS AS A FIELD MORE DEFINED
 Bioethics
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1969 Hastings Center
1971 Kennedy Institute for Ethics (Georgetown Univ.)
 1977
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institutes
Tom Beauchamp and James Childress
The Principles of Biomedical Ethics (a synthesis of
approaches and methods in biomedical decision
making)
 1995
– 2001 National Bioethics Advisory
Committee; President’s Council on Bioethics
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC
 HOSPITAL
 ETHICS
ETHICS COMMITTEESS
REVIEW BOARD
THE FUTURE OF BIOETHICS
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Brain mapping and highly precise imagine
technology – neuroethical issues to determine
personality traits and disease and behavior
predisposition: accessing a person’s memories
for legal or forensic purposes
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical
Humanities UERMMMC